_________________________________________________________ AbstractBackground Prematurity, birth asphyxia (BA), and sepsis are the leading causes of neonatal mortality. The BA prevalence rate is 23% worldwide and affects up to 39% in Rwanda. Birth asphyxia is an insult with significant consequences to the neonate's brain and other vital organs due to decreased oxygen before, during or immediately after birth. Objective To assess the BA prevalence, associated factors, and outcomes at a district hospital in Kigali. Methods A retrospective, cross-sectional study of 340 neonates admitted to the NICU in 2016. ResultsBirth asphyxia was identified in 135 out of 340 newborns (39.7%). Associated factors included gravida, meconium-stained amniotic fluid, normal duration of labor, normal duration of ROM, vaginal delivery, Apgar score of ≤5 at 5 minutes, respiratory ventilation and cardiac massage and normal birth weight (2500-3999gr). Two-thirds were born via vaginal birth (66.5%), and nearly half (47.3%) had BA. One-third was born via cesarean (33.5%), and a quarter (24.6%) had BA. Other BA outcomes included prolonged hospitalization beyond the neonatal period at 75% compared to non asphyxiated babies (25%). The mean days of NICU stay was 7.6 (SD: 6.1) for BA while it was 5.3 (SD: 4.16) for non-asphyxiated babies; early seizures (52.6%) and high specific mortality (87%). DiscussionFindings revealed a 6% BA prevalence increase, and a BA-specific mortality rate 13 times higher than previously recorded. Trained healthcare professionals need to reverse this significant trend in both vaginal and cesarean births that likely has a profound effect on the neonate, family, and community.Rwanda J Med Health Sci 2019;2(2):96-104. ________________________________________________________________________
Background Globally, nearly half of all under-five deaths occur during the neonatal period. About two million dies within the first week, of which 75% come from low-resource countries, such as Rwanda. Many neonatal deaths are preventable or avoidable if parents are knowledgeable of Neonatal Danger Signs (NDS), and do not delay seeking care at a health facility. Objective To assess the parents’ knowledge of NDS and associated factors within the neonatal period at four health centers in Kigali. Method This study was a descriptive cross-sectional design. A proportionate stratified probability sampling strategy was used to select 209 parents who attended selected health centers in Kigali. Data analysis used descriptive and inferential statistics. Results The findings showed that 67% of participants had some information on NDS. Logistic regression showed that educational level, parity, number of antenatal visits, and information from healthcare providers was significantly associated with parents' knowledge of NDS. Conclusion Our findings indicate the need to enhance education of parents’ knowledge of NDS in the study population. Educational efforts also should target NDS in health centers where most Rwandan women attend antenatal care. Rwanda J Med Health Sci 2020;3(2):128-138
Introduction Mental illnesses (MIs) are currently contributing to the worldwide burden of disease and they are among 10 main causes of disability on worldwide. In addition, mental Health care users are among the people most stigmatized by the general population which includes local leaders. Methods The design used for conducting this study was quantitative and cross-sectional survey and the study was conducted in Muhoza sector of Musanze District in Rwanda. The tool used to correct data was self-report questionnaire that included socio-demographic variables (gender, age, experience and level of education), level of contact scale and community attitudes towards mental illness-Swedish version (CAMI-S). In this study self-report questionnaire was provided to the local authorities in Muhoza sector (n=123, N=174). Data analysis was done using a statistical package for social sciences (SPSS) version 22. Results Findings from the current study revealed negative stereotypical attitudes among local authorities towards people with mental illness. The participants' total score on the CAMI-S was ranging between 24% and 81%. In addition, the study revealed some contradictions and neutral responses. Less negative stereotypical attitudes were found among participants who have university and secondary education levels than participants with primary education and those who have not completed primary school. In addition, participants with more experience in local government system reflected less negative stereotypical attitudes than participants who are less experienced in local government system. This study showed a negative correlation between level of contact and community attitudes towards mental illness. Conclusion Local authorities in a selected sector of Musanze District, hold negative stereotypical attitudes towards people with mental disorders. However, the extent of contradiction within participant responses suggests social desirability bias. Also, there is association between negative stereotypical attitudes and the level of education and experience. Finally, the results suggest that familiarity has a mediating effect on negative stereotypical attitudes.
Background Neonatal mortality is a worldwide concern, especially in sub-Sahara Africa. Millions of newborn deaths could be prevented with quality care at birth. Objective To identify immediate newborn care provided by birth attendants and associated outcomes in the delivery room of a district hospital in Kabgayi, Rwanda. Methods This study used a descriptive cross-sectional design and convenience sampling strategy. The sample of 171 newborns and birth attendants were observed in the delivery room using a standardized checklist during April and May 2019. Descriptive statistics were used to analyze data. Results The majority (65.5%) of newborns were female, and at term (93.6%). The majority had mouth and nose cleared (60%), dried thoroughly (75.4%), wet cloth removed (57.3%), delayed umbilical cord clamping (67.3%), and immediate skin-to-skin contact (67.3%). Limited interventions included APGAR evaluation (28%) and breastfeeding within the first hour (36.6%). The majority of 135(78.9%) were stable, and none died. Conclusion The majority of the study population was stable, though all newborns did not benefit from standard immediate newborn care. To reduce neonatal mortality and morbidity in Rwanda, we need to redouble efforts to strengthen the quality of immediate newborn care. Future research is needed to identify effective training to improve newborn outcomes at birth. Rwanda J Med Health Sci 2020;3(2):238-249
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